Predicting Genetic Risk for Impulsivity and Substance Use in Adolescence

Studying genetic contributions to substance initiation is crucial for identifying at-risk individuals and developing targeted prevention strategies. Investigating these factors during adolescence is vital, as this period is critical for brain development and represents an age of experimentation and initiation of substance use. Here we generate polygenic scores (PGSs), using data from the PGS catalog, across a range of substance use related traits to assess PGS in predicting i) measures of impulsivity taken from the UPPS-P questionnaire and ii) self-reported use of nicotine/tobacco, cannabis, alcohol and caffeine in early-mid adolescence. Repeat cross-sectional analyses across age bands (ages 9-10, 11-13, and 13-15) were conducted using the longitudinal Adolescent Brain Cognitive Development (ABCD) Study ® (total N=8,753; 55% female). Due to the large contribution of European-like (EUR-like) individuals in discovery samples, we performed ancestry stratified analysis in EUR-like (n=5,225), African (AFR-like; n=637) and ad-mixed (MIX-like; n=2,891) groups reflecting genetic similarity to continental ancestry groups. In the EUR-like group, PGS related to nicotine/tobacco were associated with greater impulsivity across all subscales of the UPPS-P at all ages. Analyses across ages 9-15 years old revealed PGS-impulsivity associations that: a) grew as the sample aged (e.g. Smoking Status PGS with Lack of Perseverance: 9-10 years-old: β=0.065, 11-13 years-old: β=0.11, 13-15 years-old: β=0.12) and b) others that diminished as the sample aged (e.g. Alcohol Consumption PGS with Sensation Seeking: 9-10 years-old: β=0.070, 11-13 years-old: β=0.062, 13-15 years-old: β=0.03). Evaluating the performance of PGS against self-reported substance use, PGS of nicotine/tobacco traits were associated with regular consumption of caffeine across ages. At ages 13-15, PGS of smoking traits were associated with cannabis and tobacco exposure (e.g., Smoking Initiation PGS and self-reported cannabis use, ΔR 2 =0.0094), in addition to weekly caffeine consumption. Across ages, nicotine/tobacco and alcohol PGS and regular energy drink consumption associations grew over time (e.g., Smoking Status PGS: 9-10 years-old: β=0.088, 11-13 years-old: β=0.24, 13-15 years-old: β=0.29). As with impulsivity, some PGS associations decreased over time (Alcohol Consumption PGS and self-reported alcohol use: 9-10 years-old: β=0.12, 11-13 years-old: β=0.11, 13-15 years-old: β=0.083). Replication of our EUR-like results in AFR-like and MIX-like sub-samples revealed a significant attenuation of effects, underscoring the importance of collecting genetic studies in larger ancestrally diverse cohorts. Our results highlight the dynamic relationship between genetic risk factors of substance use, trait impulsivity, and self-reported substance initiation throughout adolescence. Further, evidence here indicates caffeine consumption represents an early risk factor for problematic substance use in later life. Results support PGSs, in conjunction with larger phenotypic profiles, for identification of prevention efforts.

Self-reported knowledge, attitude and mental health status of in-school adolescents in Nigeria

BACKGROUND

 The global rise in adolescent mental health conditions highlights the need for preventive interventions particularly in schools for timely access to young people, building on inherent strengths and competencies.

AIM

 The study aims to determine the knowledge, attitude, mental health status and the predictors of mental health status of in-school adolescents.

SETTING

 The study was conducted in government-owned secondary schools in Lagos State, Nigeria. Simple random sampling was used to select one of three senatorial districts; one junior and one senior secondary school with a nurse-led school clinic were purposively selected from the sampled district.

METHODS

 Within a cross-sectional survey design, a self-administered questionnaire was used to obtain data from a sample of in-school adolescents aged 10-19 years (n = 148), enrolled in junior and senior classes.

RESULTS

 Most in-school adolescents reported poor knowledge (62.2%; n = 92) and poor attitude (54.7%; n = 81) towards mental health; 37.2% (n = 55) reported being substantially at risk of conduct problems. A high proportion (79.7%) indicated normal prosocial behaviours. Level of knowledge (odds ratio [OR] = 3.25; p  0.05; 95% confidence interval [CI] = 1.34-7.86) as well as third or higher birth order (OR = 3.46; p  0.05; 95% CI = 1.34-8.94) were significant predictors of mental health status.

CONCLUSION

 Most in-school adolescents lack knowledge, have a poor attitude towards mental health and are more likely to display conduct problems impacting their mental health status.Contribution: The study provides baseline evidence for designing in-school programmes with a mental wellness focus to promote the mental health of adolescents, leveraging professional and parental networks.

A Novel Diathesis-Stress Model of Comorbid Early Onset Psychiatric Disorders

Importance

Psychiatric comorbidity is the norm. Identifying transdiagnostic risk factors will inform our understanding of developmental pathways and early intervention targets.

Objective

We recently reported that many psychiatric outcomes are predicted by a three-factor model composed of adolescent externalizing (EXT) behaviors, early life adversity, and dopamine autoreceptor availability. Here, we investigated whether this model could be reproduced in a large population-based sample using functional magnetic resonance imaging (fMRI) instead of positron emission tomography.

Design

Data were collected by the IMAGEN consortium beginning in 2010 when cohort members were 14 years old, with follow-up testing at ages 16 and 19. These longitudinal data were used to predict psychiatric disorders by 19 years of age.

Setting

Participants were recruited from secondary schools across Europe.

Participants

Adolescents (n = 1338) with fMRI, behavioural, diagnostic, and early life trauma data.

Main Outcomes and Measures

Binary regression models tested whether a combination of EXT behaviors, childhood trauma, and mesocorticolimbic reward anticipation responses at age 14 or 19 predicted the presence of a disorder by age 19.

Results

A total of 1338 participants had the required data (52.4% female). In all models, EXT and adversity scores were significant predictors (p < 0.001). Reward anticipation responses in the ventral striatum, caudate, putamen, and anterior cingulate cortex (ACC) at age 14 (p ≤ 0.05) and in the ventral striatum at age 19 (p ≤ 0.029) were predictors in their respective models. The three-factor models overall were highly significant (p < 1.0 × 10-21), yielding greater predictive strength than each factor alone. They had an accuracy of nearly 75%, accounting for ≥ 11% (Nagelkerke R2) of the variance in psychiatric disorders. The relationship between trauma and diagnoses was partially mediated by higher EXT (indirect path B = 0.0535, 95% CI = 0.0301-0.0835), and moderated by fMRI responses in the ACC (p = 0.0038) and putamen (p = 0.0135) at age 14.

Conclusions and Relevance

The results extend our previous findings, increasing confidence in a novel diathesis-stress model of commonly comorbid early onset psychiatric disorders. The results have implications for diagnostic classification schemes and pleiotropic views of psychiatric disorder etiology.

Nucleus Accumbens Proteome Disbalance in an Adolescent Mouse Model of Schizophrenia and Nicotine Misuse Comorbidity

Background/Objectives: Schizophrenia and nicotine misuse are a comorbid condition that frequently develops during adolescence. Considering the role of the nucleus accumbens (NAcc) as a common neurobiological substrate for these psychiatric disorders, label-free proteomics was employed to identify NAcc deregulated proteins in male and female mouse models of schizophrenia with a history of adolescent nicotine exposure. Methods: Phencyclidine was used to model schizophrenia, and minipump infusions were used to model nicotine misuse. Results: Enrichment Reactome pathway and protein-protein interaction analyses showed that the cytoskeleton and associated synaptic plasticity mechanisms, energy metabolism, and nervous system development were affected in both sexes. In particular, Ncam1 (Neural cell adhesion molecule 1) could be of interest as a candidate marker of synaptic plasticity disbalance. Its deregulation in the NAcc of both sexes suggests that it lies at the core of the comorbidity pathophysiology. When considering sex-selective effects, Cs (Citrate synthase) and Mapk3 (Mitogen-activated protein kinase 3) were identified as exclusively deregulated in female and male mice, respectively. Since both proteins were previously shown to be exclusively deregulated in the medial prefrontal cortex of co-modeled mice, a common mesocortical and mesolimbic system effect can be inferred, supporting the role of aberrant energy metabolism and synaptic plasticity in the comorbidity model. Conclusions: The current data provide insights into the NAcc proteome disbalance in an adolescent preclinical model of combined schizophrenia and nicotine misuse, pointing to relevant pathways and early markers of the comorbidity.

Study protocol: an effectiveness, cost-effectiveness, and process evaluation of headspace Denmark

Introduction

Since 2013, headspace Denmark has been offered in specific areas to adolescents and young adults between 12 and 25 years, to promote youth mental health and wellbeing. Headspace provides free counselling and support, primarily delivered by trained volunteers in the headspace centres and provides information and knowledge about youth mental health, and headspace services, through community engagement. Until now, effectiveness evaluation of the Danish headspace centres has not been conducted.

Methods

Present study consists of (1) an effectiveness evaluation designed as a propensity score matched quasi-experimental trial, where the exposed person (n = 1,500), in this case the young person receiving counselling sessions at headspace, will be matched by using propensity scores to six unexposed individuals. (2) A cost-effectiveness evaluation (3) a process evaluation with predominantly qualitative methods to investigate the implementation of key activities of headspace, their mechanisms of change, and interactions with contextual factors.

Discussion

headspace centres have achieved national endorsement and are implemented in 30 municipalities in Denmark. Thus, there is a need to investigate the effectiveness of the services. Results from the evaluation can also contribute to new knowledge targeted at international youth mental health promotion initiatives. However, this evaluation is limited by selection bias since it is not possible to separate the impact of the intervention from the impact of help-seeking behaviour.

Prevalence and risk factors of obstructive sleep apnea in depression: an observational retrospective study

Background

A substantial number of previous studies have concentrated on the prevalence of depression among patients with obstructive sleep apnea (OSA). However, research regarding the prevalence of OSA among patients with depression remains relatively scarce. The aim of this study was to determine the prevalence of OSA among patients with depression and to identify the associated risk factors.

Method

A single-center retrospective chart review was conducted. The research focused on patients diagnosed with depression who were referred for a polysomnogram (PSG) during a one-year period. Patients were diagnosed with obstructive sleep apnea (OSA) if their apnea-hypopnea index (AHI) was ≥5. Using the PSG monitoring results, patients were classified into two distinct groups: the OSA group, consisting of 50 patients, and the non-OSA group, which included 109 patients. An in-depth analysis was subsequently conducted on the sleep architecture and factors associated with the risk of OSA.

Results

Among the 159 depression patients who met the subject criteria, 31.4% were diagnosed with OSA. Statistically significant differences were observed between the OSA group and the non-OSA group in terms of sex, body mass index (BMI), smoking status, and lipid levels (all p<0.05). The PSG monitoring results indicated that both the duration of non-rapid eye movement stage 3 (N3) sleep and the percentage of N3 sleep relative to total sleep time (N3/TST) were markedly lower in the OSA group than in the non-OSA group, with a statistically significant difference (p<0.01). Statistically significant differences were observed between the two groups regarding the number of awakenings, arousal index (ArI), mean oxygen saturation, oxygen saturation nadir, and oxygen desaturation index (all p<0.01). Multiple logistic regression analysis indicated that advanced age (odds ratio [OR]=1.034, 95% confidence interval [CI]: 1.004-1.065, p=0.024), female sex (OR=0.378, 95% CI: 0.171-0.837, p=0.016), low-density lipoprotein cholesterol (LDL-C) (OR=1.946, 95% CI: 1.026-3.692, p=0.041), and BMI≥25.0 kg/m² (OR=3.434, 95% CI: 1.411-8.360, p=0.007) were factors associated with OSA among patients with depression.

Conclusion

OSA was prevalent among patients with depression. Risk factors for OSA included male sex, advancing age, a BMI≥25.0 kg/m², and elevated LDL-C levels.

The prospective association of adolescent loneliness and low resilience with anxiety and depression in young adulthood: The HUNT study

BACKGROUND

Loneliness is a recognized risk factor for anxiety and depression, yet research on its interaction with low resilience remains sparse, particularly across the adolescent-to-adult transition. This study investigates how adolescent loneliness, both independently and in interaction with low resilience, influences anxiety and depression in young adulthood.

METHODS

This study utilized longitudinal data from The Trøndelag Health Study (HUNT) to track adolescents (13-19 years) from Young-HUNT3 (2006-08) through to HUNT4 (2017-19). Loneliness was assessed via a single-item measure, while resilience was estimated using the Resilience Scale for Adolescents. Anxiety and depression outcomes at the 11-year follow-up were measured using the Hospital Anxiety and Depression Scale. Multivariable logistic regression analyses were done to analyze the associations. Moreover, interaction effects were evaluated using relative excess risk due to interaction (RERI).

RESULTS

Loneliness during adolescence independently predicted anxiety and depression in young adulthood. Adolescents experiencing both loneliness and low resilience showed notably higher risks compared to other groups (highly resilient adolescents without loneliness [reference], highly resilient adolescents with loneliness, and adolescents with low resilience and low loneliness). The combined effect of loneliness and low resilience exhibited a synergistic interaction on the additive scale, although it was not statistically significant (RERI 0.13, 95% CI -2.39-2.65).

CONCLUSION

Adolescent loneliness and low resilience independently predict anxiety and depression in young adulthood. The interaction between loneliness and low resilience further heightens these risks. This underscores the importance of early interventions that focus on resilience-building during adolescence and reducing the impacts of loneliness on mental health.

The role of mind wandering and anxiety in the association between internet addiction and hyperactivity-impulsivity: a serial mediation model

BACKGROUND

Hyperactivity-Impulsivity have significant negative effects on adolescents' academic performance, physical and mental health, and social relationships. This study aims to deeply explore the relationship between Hyperactivity-Impulsivity in adolescents and Internet Addiction. Unlike previous studies, this study further explores a potential serial mediation model involving Mind Wandering and Anxiety.

METHODS

A total of 2042 adolescents completed assessments using the Internet Addiction Test (IAT), the Mind Wandering Questionnaire (MWQ), the Generalized Anxiety Disorder 2(GAD-2), and the ASRS short scale to evaluate Internet Addiction, Mind Wandering, Anxiety, and Hyperactivity-Impulsivity, respectively.

RESULTS

Internet Addiction, Mind Wandering, and Anxiety significantly influence adolescents' Hyperactivity-Impulsivity (p <.001). Mediation analysis further indicates that Internet Addiction is associated with Hyperactivity-Impulsivity through the serial mediating effects of Mind Wandering and Anxiety(p <.01). These findings highlight Mind Wandering and Anxiety as key mediators in the link between Internet Addiction and Hyperactivity-Impulsivity in adolescents.

CONCLUSIONS

This study sheds light on how Internet Addiction influences Hyperactivity-Impulsivity among adolescents and underscores the importance of preventive measures. We recommend implementing interventions aimed at fostering healthy Internet usage habits and providing robust mental health support to safeguard adolescents' physical and mental well-being.

Obsessive-compulsive symptoms and traits in patients with burning mouth syndrome: a cross-sectional multicentric analysis

OBJECTIVE

This study investigates the frequency and characteristics of obsessive-compulsive (OC) symptoms and Obsessive-Compulsive Personality Disorder (OCPD) in patients with Burning Mouth Syndrome (BMS).

BACKGROUND

Obsessive-Compulsive Disorder (OCD) is a chronic condition involving intrusive thoughts (obsessions) and repetitive behaviors (compulsions), while Obsessive-Compulsive Personality Disorder (OCPD) is a personality disorder characterized by specific traits such as perfectionism, rigidity and need for control. Both conditions frequently overlap, but their prevalence in patients with BMS has never been explored.

MATERIALS AND METHODS

A total of 151 BMS patients were assessed using the Obsessive-Compulsive Inventory-Revised (OCI-R), Compulsive Personality Assessment Scale (CPAS), Visual Analog Scale (VAS), Short-Form McGill Pain Questionnaire (SF-MPQ), Hamilton Anxiety and Depression scales (HAM-A, HAM-D), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS). Patients were grouped based on OCI and CPAS scores.

RESULTS

n = 123 (81.6%) of our sample were females, with a mean age of 63.19 ± 12.2 years. Clinically significant OC symptoms (OCI-R > 21) were observed in 41.7% of the sample, while 37% met OCPD criteria; both OC symptoms and OCPD were present in 24.5% of patients.

CONCLUSIONS

BMS patients show a high prevalence of OC symptoms and OCPD traits, which should be taken into account by clinicians and considered in the therapeutic approach, given that they could complicate symptom management.

CLINICAL RELEVANCE

By identifying these symptoms and traits through OCI-R and CPAS, clinicians may improve treatment strategies, in the perspective of a multidisciplinary tailored and personalized approach.

Joint contribution of polygenic scores for depression and attention-deficit/hyperactivity disorder to youth suicidal ideation and attempt

Children presenting comorbid attention-deficit/hyperactivity disorder (ADHD) and depression symptoms have higher risks of later suicidal ideation and attempt. However, it is unclear to what extent this risk stems from individual differences in the genetic predisposition for ADHD and/or depression. We investigated the unique and combined contribution of genetic predisposition to ADHD and depression to suicidal ideation and attempt by early adulthood. Data were from two longitudinal population-based birth cohorts, the Quebec Longitudinal Study of Child Development and the Quebec Newborn Twin Study (total N = 1207). Genetic predisposition for ADHD and depression were measured using polygenic scores. Suicidal ideation and attempt by age 20 years were self-reported via questionnaires. Across the two cohorts, suicidal ideation and attempt were reported by 99 (8.2%) and 75 (6.1%) individuals, respectively. A higher polygenic score for depression was associated with significantly higher risk of suicidal ideation and attempt, while no significant associations were found for ADHD polygenic score. However, we found an interaction between polygenic scores for depression and ADHD in the association with suicide attempt (P = 0.012), but not suicidal ideation (P = 0.897). The association between polygenic score for depression and suicide attempt was significantly stronger for individuals with a higher polygenic score for ADHD. Individuals scoring ≥ 1-SD above the mean for both polygenic scores were at increased risk for suicide attempt compared to individuals with lower scores (OR 4.03, CI 1.64-9.90), as well as compared to individuals scoring ≥ 1-SD above the mean in only depression (OR 2.92, CI 1.01-8.50) or only ADHD (OR 4.88, CI 1.56-15.26) polygenic scores. Our findings suggest that genetic predisposition for ADHD and depression contributes to increase the risk of suicide attempt in a multiplicative, rather that additive, way. Our results contribute to our understanding of the etiology of suicide risk and may inform screening and risk stratification.

17β-estradiol status alters NMDAR function and antipsychotic-like activity in female rats

Low 17β-estradiol (E2) in females of reproductive age, and marked E2 decline with menopause, contributes to heightened symptom severity in schizophrenia (i.e. cognitive dysfunction) and diminished response to antipsychotic medications. However, the underlying mechanisms are unknown. N-methyl-D-aspartate receptor (NMDAR) hypofunction contributes to the pathophysiology of schizophrenia, yet impact of E2 depletion on NMDAR function is not well characterized. Quantitative electroencephalography (qEEG), specifically gamma power, is a well-established functional readout of cortical activity that is elevated in patients with schizophrenia and is sensitive to alterations in NMDAR function. Using qEEG and touchscreen cognitive assessments, present studies investigated the effects of E2 on NMDAR function by administering MK-801 (NMDAR antagonist) to ovariectomized rats with or without E2 implants (Ovx+E and Ovx, respectively). Ovx rats were more sensitive to MK-801-induced elevations in gamma power and attentional impairments compared to Ovx+E rats. Further investigation revealed these effects were mediated by reduced synaptic GluN2A expression. Consistent with clinical reports, olanzapine (second-generation antipsychotic) was less effective in mitigating MK-801-induced elevations in gamma power in Ovx rats. Lastly, we examined antipsychotic-like activity of a Group II metabotropic glutamate receptor (mGlu2/3) positive allosteric modulator (PAM), SBI-0646535, as a novel therapeutic in E2-deprived conditions. SBI-0646535 reversed MK-801-induced elevations in gamma power regardless of E2 status. Collectively, these studies established a relationship between E2 deprivation and NMDAR function that is in part GluN2A-dependent, supporting the notion that E2 deprivation increases susceptibility to NMDAR hypofunction. This highlights the need to examine age/hormone-specific factors when considering antipsychotic response and designing novel pharmacotherapies.

Level of personality functioning and maladaptive personality traits in relation to depression and anxiety symptoms in middle and older adults

A growing body of research suggests that personality pathology underpins various mental disorders and serves as a risk factor for developing emotional disorders such as depression and anxiety. This study examined how levels of personality functioning and pathological traits predict the severity of these symptoms in a community sample of middle and older adults (N = 530). The Generalized Anxiety Disorder Questionnaire, Patient Health Questionnaire, Self and Interpersonal Functioning Scale, and Personality Inventory for ICD-11 were used. Regression analyses revealed that impaired identity and empathy significantly predicted anxiety symptoms, while only identity emerged as a predictor of depression. Self-direction and intimacy did not significantly predict either disorder. Negative Affectivity and Detachment were key predictors of anxiety, while depression was primarily related to Negative Affectivity. Variance partitioning analysis demonstrated that personality functioning and maladaptive traits independently and jointly contribute to symptom severity, with overlapping variance highlighting their interconnected roles in emotional pathology. These findings underscore the importance of assessing both personality functioning and traits when addressing emotional disorders, particularly during middle and late adulthood, a stage characterized by unique psychological and social challenges. Integrating personality assessments into routine mental health care can enhance diagnostic accuracy, improve treatment planning, and optimize outcomes for individuals with depression and anxiety.

Impulsive adolescents exhibit inefficient processing and a low decision threshold when decoding facial expressions of emotions

BACKGROUND

Borderline personality disorder (BPD) is a debilitating psychiatric illness whose symptoms frequently emerge during adolescence. Critically, self-injury and suicide attempts in BPD are often precipitated by interpersonal discord. Initial studies in adults suggest that the interpersonal difficulties common in BPD may emerge from disrupted processing of socioemotional stimuli. Less is known about these processes in adolescents with BPD symptoms, despite substantial changes in socioemotional processing during this developmental period.

METHODS

Eighty-six adolescents and young adults with and without BPD symptoms completed an emotional interference task involving the identification of a facial emotion expression in the presence of a conflicting or congruent emotion word. We used hierarchical drift diffusion modeling to index speed of processing and decision boundary. Using Bayesian multilevel regression, we characterized age-related differences in facial emotion processing. We examined whether BPD symptom dimensions were associated with alterations in facial emotion processing. To determine the specificity of our effects, we analyzed behavioral data from a corresponding nonemotional interference task.

RESULTS

Emotion-related impulsivity, but not negative affectivity or interpersonal dysfunction, predicted inefficient processing when presented with conflicting negative emotional stimuli. Across both tasks, emotion-related impulsivity in adolescents, but not young adults, was further associated with a lower decision boundary - resulting in fast but inaccurate decisions.

CONCLUSION

Impulsive adolescents with BPD symptoms are prone to making errors when appraising facial emotion expressions, which may potentiate or worsen interpersonal conflicts. Our findings highlight the role of lower-level social cognitive processes in interpersonal difficulties among vulnerable youth during a sensitive developmental window.

Sex and age effects on prevalence of CYP2C19 and CYP2D6 Phenoconversion risk over time in patients with psychosis

Pharmacogenetics in psychiatry may have benefits for medication treatment success. However, medication regimes leading to drug-drug interactions and potential phenoconversion of actionable pharmacogenetic phenotypes challenge the application of pharmacogenetics. Although polypharmacy is common, its impact in patients with psychosis is understudied, even though these patients might benefit from pharmacogenetics-guided medication adjustment. Here, we investigated the impact of two pharmacogenes relevant in psychiatric practice, CYP2C19 and CYP2D6, and the effect of sex and age. Medication use and predicted occurrence of phenoconversion was examined in a sample of patients with psychosis over a period of approximately six years. Bayesian statistics were applied to examine longitudinal effects. Our results show that women used more medications, including CYP2C19 and CYP2D6 inhibitors and (actionable) substrates. No significant sex or age differences were found for phenoconversion of either enzyme. A sex-effect on CYP2C19 inhibitor use was found but appeared to be driven by weakly inhibiting oral contraceptives, which were reported only in women. The phenoconversion rate for both enzymes appeared to change over time, suggesting that phenoconversion is a dynamic state that may affect patients differently over their lifetime. To further improve treatment in this patient population, long-term and regular updated medication monitoring in (pharmacogenetic) research as well as application in practice are recommended.

A computational approach to understanding effort-based decision-making in depression

Objective

Motivational dysfunction is a core feature of depression, and can have debilitating effects on everyday function. However, it is unclear which disrupted cognitive processes underlie impaired motivation, and whether impairments persist following remission. Decision-making concerning exerting effort to obtain rewards offers a promising framework for understanding motivation, especially when examined with computational tools which can offer precise quantification of latent processes.

Methods

Effort-based decision-making was assessed using the Apple Gathering Task, in which participants decide whether to exert effort via a grip-force device to obtain varying levels of reward; effort levels were individually calibrated and varied parametrically. We present a comprehensive computational analysis of decision-making, initially validating our model in healthy volunteers (N=67), before applying it in a case-control study including current (N=41) and remitted (N=46) unmedicated depressed individuals, and healthy volunteers with (N=36) and without (N=57) a family history of depression.

Results

Four fundamental computational mechanisms that drive patterns of effort-based decisions, which replicated across samples, were identified: overall bias to accept effort challenges; reward sensitivity; and linear and quadratic effort sensitivity. Traditional model-agnostic analyses showed that both depressed groups showed lower willingness to exert effort. In contrast with previous findings, computational analysis revealed that this difference was primarily driven by lower effort acceptance bias, but not altered effort or reward sensitivity.

Conclusions

This work provides insight into the computational mechanisms underlying motivational dysfunction in depression. Lower willingness to exert effort could represent a trait-like factor contributing to symptoms, and might represent a fruitful target for treatment and prevention.

Elevating the Discourse on the Comorbidity and Treatment of Eating Disorders and Autism Spectrum Disorder: Commentary on Inal-Kaleli et al. and Nimbley et al

Two recent review papers published in the International Journal of Eating Disorders have considerably elevated the rigor of scholarship on the comorbidity between autism spectrum disorder (ASD) and eating disorders. One paper reported that more than one-quarter of individuals with acute anorexia nervosa also have ASD, and that autistic traits are positively correlated with eating disorder psychopathology. The other paper reported that, compared to individuals with low autistic traits, those with high autistic traits report poorer experiences of eating disorder treatment, despite similar treatment outcomes. While both papers make excellent points, in this commentary we highlight important challenges in the assessment of ASD that may artificially inflate its prevalence in the context of disordered eating. We then caution the field against completely discarding evidence-based eating disorder treatments in the setting of comorbid ASD. Finally, we offer recommendations for future research to determine when and how eating disorder treatments should be modified to accommodate neurodiversity.

Hospitalizations for depressive disorders in Ecuador: An eight-year nationwide analysis of trends and demographic insights

BACKGROUND

Sociodemographic characteristics and limited mental health care access may contribute to higher depression rates in low- and middle-income countries. This study aimed to analyze nationwide depressive disorder hospitalizations in Ecuador.

METHODS

We assessed the sociodemographic characteristics, severity, recurrence, and duration of hospitalizations for depressive disorders. The dataset used is publicly available on the Ecuadorian National Institute of Statistics and Censuses website. Multivariable multinomial logistic regression was performed to calculate adjusted relative risk ratios (aRRR).

RESULTS

14,586 hospitalizations were analyzed during 2015-2022. There was a significant increase in depressive disorders hospitalizations, from 9.41 cases per 100,000 inhabitants in 2015 to 13.9 in 2022. Females accounted for 65.7 % of hospital admissions. Depressive disorder hospitalizations had a mean age of 33.43 years. Severe depressive disorders without psychotic symptoms had the highest average hospitalization rate during 2015-2022 with 3.53 cases per 100,000 inhabitants. Individuals aged 20-29 years (aRRR 1.68, 95 % CI 1.27-2.22) and those aged 30-39 years (aRRR 1.81, 95 % CI 1.32-2.47) had higher probabilities of hospitalization for severe depressive disorder without psychotic symptoms. Patients with severe depression with or without psychotic symptoms were more likely of being hospitalized for seven or more days. Ethnic minorities were less likely to be hospitalized for severe depressive disorder without psychotic symptoms.

CONCLUSION

These findings highlight the increasing rates of depressive disorders in low- and middle-income countries such as Ecuador and emphasize the necessity for public health strategies focused on vulnerable groups.

Eating disorders among people with and without type 1 diabetes: incidence and treatment in a nationwide population-based cohort

AIMS/HYPOTHESIS

Eating disorders are over-represented in type 1 diabetes and are associated with an increased risk of complications, but it is unclear whether type 1 diabetes affects the treatment of eating disorders. We assessed incidence and treatment of eating disorders in a nationwide sample of individuals with type 1 diabetes and diabetes-free control individuals.

METHODS

Our study comprised 11,055 individuals aged <30 who had been diagnosed with type 1 diabetes in 1998-2010, and 11,055 diabetes-free control individuals matched for age, sex and hospital district. We ascertained incidence of eating disorders from hospital records using Poisson regression. Eating disorder treatment was assessed by new prescriptions for psychotropic medications and hospital treatment for eating disorders.

RESULTS

During a mean follow-up of 13.1 years, there were 175 incident cases of eating disorders among individuals with type 1 diabetes and 75 among the control individuals (adjusted incidence rate ratio 2.35; 95% CI 1.80, 3.09). The prescription of psychotropic medications was similar among eating disorder patients with and without type 1 diabetes. However, those with type 1 diabetes received outpatient hospital treatment for their eating disorder less often than those without diabetes (mean 3.32 vs 5.33 outpatient care visits per year [adjusted difference 1.24; 95% CI 0.39, 2.08]).

CONCLUSIONS/INTERPRETATION

People with type 1 diabetes are more likely to be diagnosed with eating disorders than their diabetes-free peers. However, they receive less outpatient hospital treatment for their eating disorders despite their greater risk for major adverse health outcomes. These findings emphasise the need for targeted eating disorder treatment for people with type 1 diabetes.

Development of serious mental illness in young adult violent offenders: Early-life risk factors and long-term adverse outcomes

This study explored serious mental illness (SMI) in young adult offenders imprisoned for violent or sexual crimes, estimating the effects of neurodevelopmental disorders and early-life risk factors on the development of SMI, and its prospective long-term adverse outcomes. An all-male cohort of 266 violent offenders, assessed during imprisonment when aged 18-25 years (M = 21.8, SD = 1.9), was followed prospectively (Myears = 6.2, SD = 1.3) in Swedish national registers together with a general population group (n = 10,000). The baseline prevalence of SMI in late adolescence or young adulthood was 10 % (n = 26) in the violent offender cohort. Childhood-onset conduct disorder (OR 2.7 [1.0-7.1]) was associated with SMI in multivariable logistic regression analyses. Prospectively, violent offenders with, versus without, SMI exhibited heightened total crime rate (IRR 1.4 [1.0-2.2]), prison reconvictions (IRR 1.5 [1.0-2.1]), and psychiatric inpatient care (IRR 3.7 [1.6-8.4]), in zero-inflated Poisson regression models. The usage of outpatient psychiatric and somatic care was low in violent offenders with SMI, even relative to the general population group. The results emphasize the need for early identification of at-risk children, such as those with childhood-onset conduct disorder, and challenges with engaging violent offenders with SMI in healthcare.

Differences in HIV Outcomes and Quality of Life Between Older and Younger Black Women With HIV in the United States, 2021-2023

Objectives. To characterize differences in outcomes of 733 Black women aged 50 years and older compared with younger women with HIV engaged in bundled interventions across 12 US sites from 2021 to 2023. Methods. We examined age differences in physical component score (PCS) and mental component score (MCS) for health-related quality of life, stigma, and viral suppression over 12 months. We examined outcome effects by age and intervention. We collected comorbidities and preventive health screenings. Results. Lower PCS was associated with each year with HIV for older women (b = -0.13; 95% confidence interval [CI] = -0.25, -0.02) and for younger women in the stigma reduction intervention (b = -3.36; 95% CI = -5.88, -0.84). Younger women in the intimate partner violence intervention demonstrated a decrease in MCS quality of life (b = -3.07; 95% CI = -5.16, -0.98). Stigma scores were increased for younger women in the Red Carpet Experience (b = 2.70; 95% CI = 0.07, 5.33) but lower for older women in the self-efficacy intervention (b = -1.41; 95% CI = -2.24, -0.57). Viral load suppression was associated with peer-patient navigation for older women (adjusted odds ratio [AOR] = 4.73; 95% CI = 1.51, 14.81) and the intimate partner violence intervention for younger women (AOR = 3.83; 95% CI = 2.15, 6.82). Health screenings were low. Conclusions. Interventions that center Black women beyond traditional HIV treatment are needed with a focus on health screenings to improve the quality of life of older women. (Am J Public Health. 2025;115(S1):S57-S67. https://doi.org/10.2105/AJPH.2025.308021).

Depression and Social Media Use in Children and Adolescents

Since the opening of Facebook to the general public in late 2006 social media use has rapidly become nearly universal among adolescents, providing new opportunities for connecting with peers, exploring identity, and expressing creativity. During the same period, rates of depression and suicide among youth have risen. A growing body of evidence highlights a correlation between problematic social media use and depression. Social media does not affect all children and adolescents equally.

The prevalence, characteristics, and psychological wellbeing of unpaid carers in the United Kingdom

BACKGROUND

This study sought to describe the characteristics of unpaid carers in the UK and assess levels of depression, anxiety, and mental health treatment seeking behaviours in this population.

METHODS

Data was derived from Wave 9 (n = 2790) of the COVID-19 Psychological Research Consortium (C19PRC) study, a longitudinal survey of adults in the UK. Logistic regression analyses were conducted to examine the characteristics of unpaid carers, association between caregiver status and psychological wellbeing, and caregiver-specific factors associated with risk of poor psychological wellbeing.

RESULTS

Approximately 15% (n = 417) of the sample reported providing unpaid care. Younger age, having three or more children in the household, and lower income were identified as significant correlates of caregiver status. Unpaid caregivers were at increased risk of depression or anxiety and mental health help-seeking. Unpaid caregivers who were younger, lived in households with one or two children, and had a lower income were at greater risk of depression or anxiety and engaging in mental health help-seeking. Caring for an individual with a terminal illness, long-term illness, learning disability or difficulty, mental health problems, physical disability, and other were linked to increased risk of depression or anxiety, while caring for someone with a learning disability increased risk of mental health help-seeking.

CONCLUSIONS

This study indicates that at least one in eight people in the UK provide unpaid care, and that those who provide unpaid care have a far higher risk of experiencing depression or anxiety and seeking mental health treatment. The identification of risk factors associated with these mental health outcomes will facilitate the identification of those in most need of support.

Trajectories of Psychopathology Among Youth with Physical Illness

The objectives of this study were to characterize 24-month trajectories of psychopathology, validate psychopathology groups, and identify youth, parent, family, and neighbourhood characteristics associated with each identified trajectory in a sample of youth with chronic physical illness (CPI). Data come from a longitudinal study of 263 youth aged 2-16 years diagnosed with CPI and their parents. Participants were recruited from outpatient clinics at a pediatric hospital in Canada and assessed at recruitment (baseline), 6, 12, and 24 months. Parents reported on youth psychopathology using the Emotional Behavioural Scales. Latent class growth analysis was used to identify trajectories of psychopathology. Baseline predictors of trajectory group membership were investigated using multinomial logistic regression. Three distinct psychopathology trajectories best fit the data; the model had a BIC of -3579.70 and average posterior probabilities of 0.97. The trajectories were classified as, low-stable (LS: n = 156, 58%), moderate-decreasing (MD: n = 85, 34%), and high-decreasing (HD: n = 21, 8%). Youth who were older [HD: OR = 1.33 (1.05, 1.69)], had higher disability scores [HD: OR = 1.31 (1.19, 1.45) and MD: OR = 1.14 (1.08, 1.21)], had parents with greater psychological distress scores [HD: OR = 1.11 (1.05, 1.18) and MD: OR = 1.04 (1.01, 1.07)], and came from households with higher incomes [HD: OR = 4.67 (1.06, 20.67)] were associated with higher psychopathology trajectories compared to LS. Parent-reported youth psychopathology was generally low over 24 months, though over one-third had symptoms that reflected borderline clinical psychopathology. Predictors for group membership could help identify at-risk youth with CPI early for psychopathology.

Parasomnias and sleep-related movement disorders induced by drugs in the adult population: a review about iatrogenic medication effects

Parasomnias and sleep-related movement disorders (SRMD) are major causes of sleep disorders and may be drug induced. The objective of this study was to conduct a systematic review of the literature to examine the association between drug use and the occurrence of parasomnias and SRMD. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for reporting systematic reviews, we searched PubMed databases between January 2020 and June 2023. The searches retrieved 937 records, of which 174 publications were selected for full-text screening and 73 drugs were identified. The most common drug-induced parasomnias were nightmares and rapid eye movement (REM) sleep behaviour disorders and sleepwalking. In terms of drug-induced SRMD, restless legs syndrome, periodic limb movement disorders (PLMD), and sleep-related bruxism were most frequent. Medications that inhibit noradrenergic, serotonergic, or orexin transmission could induce REM sleep (e.g., nightmares). Regarding sleepwalking, dysregulation of serotoninergic neurone activity is implicated. Antipsychotics are mentioned, as well as medications involved in the gamma-aminobutyric acid (GABA) pathway. A mechanism of desensitisation-autoregulation of GABA receptors on serotoninergic neurones is a hypothesis. SRMD and PLMD could involve medications disrupting the dopamine pathway (e.g., antipsychotics or opioids). Opioids would act on mu receptors and increase dopamine release. The role of adenosine and iron is also hypothesised. Regarding bruxism, the hypotheses raised involve dysregulation of mesocortical pathway or a downregulation of nigrostriatal pathway, related to medications involving dopamine or serotonin. Parasomnias are rarely identified in drug product labels, likely due to the recent classification of their diagnoses. An analysis of pharmacovigilance data could be valuable to supplement existing literature data.

Mindful young brains and minds: a systematic review of the neural correlates of mindfulness-based interventions in youth

This systematic narrative review examines neuroimaging studies that investigated the neural correlates of mindfulness-based interventions in youth (ages 0-18). We extracted 13 studies with a total of 467 participants aged 5-18 years from the MEDLINE database on February 21st, 2024. These studies included both typically developing youth and those at risk of developing or recovering from neuropsychiatric disorders. Most studies (76.9%) utilized a pre-post intervention design, with resting-state functional magnetic resonance imaging (fMRI) being the most common imaging modality (46.1%), followed by task-based fMRI (38.4%), diffusion-weighted imaging (15.4%), and structural MRI (7.7%). Despite substantial heterogeneity across study designs and findings, several consistent patterns emerged. Resting-state fMRI studies generally reported increased functional connectivity within and between networks, notably involving the salience network, frontoparietal network, and default mode network. Studies using diffusion-weighted imaging indicated enhancements in white matter microstructural properties, supporting overall connectivity improvements. Several task-based fMRI studies identified decreased activation of the default mode network and heightened reactivity of the salience network during or after mindfulness practice, with real-time neurofeedback further amplifying these effects. While preliminary, the reviewed studies suggest that mindfulness interventions may alter both functional and structural connectivity and activity in youth, potentially bolstering self-regulation and cognitive control. Nonetheless, the variability in methodologies and small sample sizes restricts the generalizability of these results. Future research should prioritize larger and more diverse samples, and standardized mindfulness-based interventions to deepen our understanding of the neural mechanisms underlying mindfulness-based interventions in youth and to optimize their efficacy.

Association of Psychological Problems for Which Help Was Sought With Physical Illness

INTRODUCTION

Persons with mental disorders are at increased risk for physical illness. Individuals who seek help for psychological problems might benefit from timely support and interventional approaches. This study aimed to explore the associations between psychological problems for which help was sought and physical illness.

METHODS

The 7th survey of the Tromsø Study, which included 21,083 participants aged ≥40 years, was used in the study. The main exposure was psychological problems for which help was sought. Main outcomes were lifetime prevalence and time to onset of physical illness. Associations between psychological problems and physical illness were analyzed using logistic regression and survival analysis and adjusted for sex, birth year, smoking, education, and income. Data were collected in 2015-2016 and analyzed in 2023-2024.

RESULTS

Psychological problems were associated with smoking and having lower income but higher educational attainment. Psychological problems were associated with lifetime prevalence of hypertension, coronary artery disease, heart failure, atrial fibrillation, stroke, kidney disease, chronic obstructive pulmonary disease, asthma, arthrosis, migraine, chronic pain, and cancer; ORs ranged from 1.15 (95% CI=1.04, 1.27) to 2.15 (95% CI=1.76, 2.62). Survival analysis demonstrated that individuals with psychological problems are at increased risk for subsequent physical illness; hazard ratios ranged from 1.18 (95% CI=1.06, 1.32) to 2.74 (95% CI=2.06, 3.65).

CONCLUSIONS

This study found that psychological problems with or without a diagnosis of mental disorder might be an important marker of increased risk for physical illness.

Annual Research Review: Psychosis in children and adolescents - a call to action: a commentary on Kelleher (2025)

The spectrum of psychosis is highly relevant to child and adolescent mental health. Psychotic symptoms are common in children and adolescents. The onset of psychotic disorders is often preceded by neurodevelopmental problems in early childhood, and some 13% of adolescents attending specialist mental health services will later be diagnosed with a psychotic disorder or bipolar disorder. Although 12% of psychotic disorders and 8% of schizophrenia cases have onset prior to age 18, there is little evidence available to guide the clinical care of young people with early onset psychosis. This commentary summarises the key findings of the annual research review on Psychosis in Children and Adolescents. It highlights the urgent need for clinicians and researchers in child and adolescent mental health to contribute to finding solutions to prevent the onset of psychosis and improve the lives of young people with early onset psychosis and their families.

Interparental Relationship Discord and Adolescent Psychopathology in a United States Probability Sample

Exposure to interparental conflict and poor parental relationship adjustment (i.e., interparental relationship discord) has been associated with children's internalizing and externalizing symptoms throughout childhood and later life. However, the degree to which interparental relationship discord is associated with clinical levels of psychopathology in adolescents remains unclear. The association between parents' report of interparental relationship discord and mental disorders in adolescents was investigated in the National Comorbidity Survey-Adolescent Supplement, a United States probability sample of 13-17-year-old adolescents and their parents (N = 4,112 dyads). A hierarchical framework, consisting of 16 specific disorders, latent dimensions of internalizing and externalizing disorders, and a latent dimension of general psychopathology, was employed. Greater interparental relationship discord demonstrated small but significant associations with higher levels of general psychopathology and internalizing and externalizing psychopathology, as well as with several specific disorders. Overall, results are consistent with the perspective that interparental relationship discord may increase risk for clinical levels of psychopathology in adolescents.

An examination of sociodemographic and clinical factors influencing help-seeking attitudes and behaviors among adolescents with mental health problems

This study investigated sociodemographic and clinical factors influencing help-seeking attitudes and behavior among adolescents with mental health problems. As part of the ProHEAD ("Promoting Help-seeking using E-technology for ADolescents") consortium a school-based, online assessment of sociodemographic information, psychopathology, risk-taking and self-harming behavior, help-seeking attitudes and behavior, and barriers to help-seeking was conducted in adolescents aged ≥ 12 years recruited from randomly selected schools in five regions of Germany. Linear regression analyses with the LMG formula were performed to explore predictors of help-seeking attitudes and behavior and assess their relative importance. Nine thousand five hundred and nine participants (95.5%) completed the online assessment (mean age: 15.1 years, 58.6% female). In total, 1606 participants (16.9%) showed relevant mental health problems (e.g., depressive and eating disorder symptoms, alcohol problems, and thoughts of self-harming behavior). Among them, 895 (55.7%) reported having sought help (lifetime), with higher rates for informal (n = 842, 52.4%) compared to professional (n = 380, 23.7%) sources. High help-seeking propensity emerged as the most important factor contributing to professional help-seeking, followed by elevated levels of psychopathology and perceived barriers, with sociodemographic factors being less impactful. Psychopathological severity also outweighed sociodemographic factors in predicting negative help-seeking attitudes. These findings indicate that attitudes towards seeking professional help, perceived barriers, and psychopathology severity critically influence limited adolescent help-seeking behavior. This emphasizes the need for initiatives that promote help-seeking, reduce negative attitudes, and address structural barriers in adolescent mental health care.

Contribution of Rare and Potentially Functionally Relevant Sequence Variants in Schizophrenia Risk-Locus Xq28,distal

Duplications of the Xq28,distal locus have been described in male and female patients with schizophrenia (SCZ) or intellectual disability. The Xq28,distal locus spans eight protein-coding genes (F8, CMC4, MTCP1, BRCC3, VBP1, FUNDC2, CLIC2, and RAB39B) and is flanked by recurrent genomic breakpoints. Thus, the issue of which gene/s at this locus is/are relevant in terms of SCZ pathogenesis remains unclear. The aim of this study was to investigate the contribution of rare and potentially functionally relevant sequence variants within the Xq28,distal locus to SCZ risk using the single-molecule molecular inversion probes (smMIP) method. Targeted sequencing was performed in a cohort of 1935 patients with SCZ and 1905 controls of European ancestry. The consecutive statistical analysis addressed two main areas. On the level of the individual variants, allele counts in the patient and control cohort were systematically compared with a Fisher's exact test: (i) for the entire present study cohort; (ii) for patients and controls separated by sex; and (iii) in combination with data published by the Schizophrenia Exome Meta-Analysis (SCHEMA) consortium. On the gene-wise level, a burden analysis was performed using the X-chromosomal model of the Optimal Unified Sequence Kernel Association Test (SKAT-O), with adjustment for possible sex-specific effects. Targeted sequencing identified a total of 13 rare and potentially functional variants in four patients and 11 controls. However, neither at the level of individual rare and potentially functional variants nor at the level of the eight protein-coding genes at the Xq28,distal locus was a statistically significant enrichment in patients compared to controls observed. Although inconclusive, the present findings represent a step toward improved understanding of the contribution of X-chromosomal risk factors in neuropsychiatric disorder development, which is an underrepresented aspect of genetic studies in this field.

Molecular and Behavioral Neuroprotective Effects of Clavulanic Acid and Crocin in Haloperidol-Induced Tardive Dyskinesia in Rats

Clavulanic acid (ClvA), a beta-lactamase inhibitor, is being explored for its significant neuroprotective potential. The effects of ClvA were assessed both individually and in combination with crocin (Cr), an antioxidant derived from saffron, in the context of tardive dyskinesia (TD). In rat haloperidol (Hp)-induced-TD (1 mg/kg, i.p. 21 days), the effects of ClvA (50, 100, 150 mg/kg) and Cr (10, 20, 40 mg/kg) were assessed via vacuous chewing movements (VCM) and tongue protrusion (TP). Striatal malondialdehyde (MDA) and glutathione (GSH) were measured spectrophotometrically. Based on the results, ClvA (100 mg/kg) and Cr (10 mg/kg) were determined with sub-effective doses. Glutamate transporter-subtype1 (GLT1), dopamine active transporter (DAT), vesicular monoamine transporter-type2 (VMAT2), Bax/Bcl2, cleaved Caspase3, phosphorylated AKT/AKT, IL1β, and TNFα levels were quantified using western blotting in sub-effective doses and their combination. The behavioral results of catalepsy and orofacial dyskinesia demonstrated model establishment. Hp decreased GLT1 (p < 0.05), DAT (p < 0.01), VMAT2 (p < 0.001), GSH and pAKT/AKT (p < 0.0001); increased TNFα (p < 0.05), IL1β, cleaved Caspase3 (p < 0.001); MDA and Bax/Bcl2 (p < 0.0001). ClvA 100 mg/kg reversed the decreased GLT1 and VMAT2 (p < 0.01), alongside the increased MDA (p < 0.0001) and VCM (p < 0.05). It also increased AKT phosphorylation (p < 0.05). No effects were noted on DAT, GSH, Bax/Bcl2, or inflammatory factors. However, the combination with Cr at 10 mg/kg influenced ClvA on DAT (p < 0.01) and resulted in a significant increase in GSH (p < 0.0001). Additionally, there was a marked decrease in TNFα (p < 0.0001) and IL1β (p < 0.001), enhancing its effects on reducing MDA and increasing pAKT/AKT (p < 0.0001). The combination adversely affected GLT1. ClvA protects against TD via GLT1 and VMAT2; combined with Cr, it enhances antioxidant effects, improves DAT, and requires dose optimization for GLT1 disruption.

Annual Research Review: Psychosis in children and adolescents: key updates from the past 2 decades on psychotic disorders, psychotic experiences, and psychosis risk

Psychosis in children and adolescents has been studied on a spectrum from (common) psychotic experiences to (rare) early-onset schizophrenia spectrum disorders. This research review looks at the state-of-the-art for research across the psychosis spectrum, from evidence on psychotic experiences in community and clinical samples of children and adolescents to findings from psychosis risk syndrome research, to evidence on early-onset psychotic disorders. The review also looks at new opportunities to capture psychosis risk in childhood and adolescence, including opportunities for early intervention, identifies important unanswered questions, and points to future directions for prevention research.

Beyond case-control study in neuroimaging for psychiatric disorders: Harmonizing and utilizing the brain images from multiple sites

Recent magnetic resonance imaging (MRI) research has advanced our understanding of brain pathophysiology in psychiatric disorders. This progress necessitates re-evaluation of the diagnostic system for psychiatric disorders based on MRI-based biomarkers, with implications for precise clinical diagnosis and optimal therapeutics. To achieve this goal, large-scale multi-site studies are essential to develop a standardized MRI database, with the analysis of several thousands of images and the incorporation of new data. A critical challenge in these studies is to minimize sampling and measurement biases in MRI studies to accurately capture the diversity of disease-derived biomarkers. Various techniques have been employed to consolidate datasets from multiple sites in case-control studies. Traveling subject harmonization stands out as a powerful tool that can differentiate measurement bias from sample variety and sampling bias. A non-linear statistical model for a normative trajectory across the lifespan also strengthens the database to mitigate sampling bias from known factors such as age and sex. These approaches can enhance the alterations between psychiatric disorders and integrate new data and follow-up scans into existing life-course trajectory, enhancing the reliability of machine learning classification and subtyping. Although this approach has been developed using T1-weighted structural image features, future research may extend this framework to other modalities and measures. The required sample size and methodological establishment are needed for future investigations, leading to novel insights into the brain pathophysiology of psychiatric disorders and the development of optimal therapeutics for bedside clinical applications. Sharing big data and their findings also need to be considered.

Schizophrenia is associated with altered DNA methylation variance

Varying combinations of genetic and environmental risk factors are thought to underpin phenotypic heterogeneity between individuals in psychiatric conditions such as schizophrenia. While epigenome-wide association studies in schizophrenia have identified extensive alteration of mean DNA methylation levels, less is known about the location and impact of DNA methylation variance, which could contribute to phenotypic and treatment response heterogeneity. To explore this question, we conducted the largest meta-analysis of blood DNA methylation variance in schizophrenia to date, leveraging three cohorts comprising 1036 individuals with schizophrenia and 954 non-psychiatric controls. Surprisingly, only a small proportion (0.1%) of the 213 variably methylated positions (VMPs) associated with schizophrenia (Benjamini-Hochberg FDR < 0.05) were shared with differentially methylated positions (DMPs; sites with mean changes between cases and controls). These blood-derived VMPs were found to be overrepresented in genes previously associated with schizophrenia and amongst brain-enriched genes, with evidence of concordant changes at VMPs in the cerebellum, hippocampus, prefrontal cortex, or striatum. Epigenetic covariance was also observed with respect to clinically significant metrics including age of onset, cognitive deficits, and symptom severity. We also uncovered a significant VMP in individuals with first-episode psychosis (n = 644) from additional cohorts and a non-psychiatric comparison group (n = 633). Collectively, these findings suggest schizophrenia is associated with significant changes in DNA methylation variance, which may contribute to individual-to-individual heterogeneity.

Unresolved ethical issues of genetic counseling and testing in clinical psychiatry

OBJECTIVE

This position article discusses current major ethical and social issues related to genetic counseling and testing in clinical psychiatry (PsyGCT).

METHODS

To address these complex issues in the context of clinical psychiatry relevant to PsyGCT, the interdisciplinary and pan-European expert Network EnGagE (Enhancing Psychiatric Genetic Counseling, Testing, and Training in Europe; CA17130) was established in 2018. We conducted an interdisciplinary, international workshop at which we identified gaps across European healthcare services and research in PsyGCT; the workshop output was summarized and systematized for this position article.

RESULTS

Four main unresolved ethical topics were identified as most relevant for the implementation of PsyGCT: (1) the problematic dualism between somatic and psychiatric disorders, (2) the impact of genetic testing on stigma, (3) fulfilling professional responsibilities, and (4) ethical issues in public health services. We provide basic recommendations to inform psychiatrists and other healthcare professionals involved in the clinical implementation of PsyGCT and conclude by pointing to avenues of future ethics research in PsyGCT.

CONCLUSION

This article draws attention to a set of unresolved ethical issues relevant for mental health professionals, professionals within clinical genetics, patients and their family members, and society as a whole and stresses the need for more interdisciplinary exchange to define standards in psychiatric counseling as well as in public communication. The use of PsyGCT may, in the future, expand and include genetic testing for additional psychiatric diagnoses. We advocate the development of pan-European ethical standards addressing the four identified areas of ethical-practical relevance in PsyGCT.

Refugee Migration Background and Healthcare Contacts Prior to First-Episode Psychosis in Young Adults in Denmark and Sweden: Are Patterns Consistent Across Countries?

INTRODUCTION

The objective of this study was to examine group differences in healthcare contacts prior to a first diagnosis of non-affective psychotic disorders (NAPDs) comparing young refugees settled in Denmark and Sweden before turning 18 non-refugee migrants and native-born individuals.

METHODS

Using nationwide register data, we identified all individuals aged 18-35 who received an NAPD diagnosis during 2006-2018. Healthcare contacts for other psychiatric disorders were categorised as inpatient, outpatient (grouped by discharge diagnosis) or dispensed antidepressant medication. Logistic regression was used in each country to compare contacts within 12 months prior to NAPD diagnosis, yielding odds ratios (OR) and corresponding 95% confidence intervals (CI), while standardised prevalence ratios (SPR), reported in percentages, were used to compare healthcare contact across countries.

RESULTS

We included 11,679 individuals in Denmark and 11,088 in Sweden. The likelihood of prior contact of any type was lower in both countries for both refugees [Denmark: OR = 0.75(CI: 0.63, 0.90); Sweden: OR = 0.61(CI: 0.55, 0.68)] and non-refugee migrants [Denmark: OR = 0.78(CI: 0.64, 0.95); Sweden: OR = 0.55(CI: 0.49, 0.62)] compared with majority peers. The largest differences were observed for dispensed antidepressants in both countries [Denmark: ORrefugees = 0.58(CI: 0.47, 0.71); Sweden: ORrefugees = 0.52(CI: 0.45, 0.61)]. Outpatient contacts in particular were more common in Sweden than in Denmark across all groups [SIRrefugees = 151% (CI: 125, 180)].

CONCLUSION

Young refugees and non-refugee migrants in both Denmark and Sweden were less likely to have healthcare contact for other psychiatric disorders prior to NAPD onset than host populations. As healthcare contacts offer opportunities to identify treatment needs early, these groups may be vulnerable to delays in the pathway to treatment.

An Investigation of the Longitudinal Bidirectional Associations Between Interactive Versus Passive Social Media Behaviors and Youth Internalizing Difficulties. A Within-Person Approach

Ongoing concerns about the mental health of young people have intensified interest in the role of social media, with research suggesting that the nature of social media behaviors-whether interactive or passive-may differentially impact mental health. However, the bidirectional relationships between specific types of social media use and internalizing difficulties (anxiety and depression) remain underexplored, particularly at the within-person level over time. Data were extracted from the Dutch population-based Longitudinal Internet Studies for the Social Sciences (LISS) panel. Four yearly studies assessing time spent on interactive (communication) and passive use of social media in October (2019-2022) and four annual studies evaluating internalizing difficulties (anxiety and depression) in November (2019-2022) were used. Respondents who were 16- 25 years old in October 2019 (N = 321; M = 20.49; SD = 2.94; 61.7% female). Random Intercept Cross Lagged Path Models were used to analyze the data. There were no significant associations between passive social media use and internalizing difficulties at the within-person level over time. Within-person interactive use was associated with decreases in internalizing difficulties at one time point (2021 to 2022). The results provide marginal evidence that distinct social media behaviors are prospective factors associated with internalizing difficulties in young people.

Continuous Dopamine D2 Receptor Blockade and Long-Term Outcome in First-Episode Schizophrenia

OBJECTIVE

It is not known what proportion of patients experience relapse in first-episode schizophrenia despite continuous dopamine D2 receptor blockade and whether breakthrough psychosis is attributable to long-term use of D2-blocking antipsychotics. Using data from a Finnish nationwide cohort, the authors sought to test the hypothesis that the incidence of breakthrough psychosis is accelerated among previously relapse-free patients receiving continuous D2 antagonist treatment beyond 5 years.

METHODS

All persons age 45 years or younger with first-episode schizophrenia were identified from the nationwide registry of inpatient care for the years 1996-2014. The primary outcome was a severe relapse leading to hospitalization among those treated continuously with long-acting injectable (LAI) antipsychotics. The secondary outcome was the incidence rate ratio (IRR) of relapse during years 2-10, using year 1 as the reference.

RESULTS

A total of 305 patients initiated ensured LAI use during the first 30 days of follow-up. Kaplan-Meier analysis showed that during the 10-year follow-up, their cumulative probability of relapse was 45% (95% CI=35-57). The annual relapse incidence per person-year decreased from 0.26 (95% CI=0.20-0.35) during the first year to 0.05 (95% CI=0.01-0.19) during the fifth year, corresponding to an IRR of 0.18 (95% CI=0.04-0.74). During years 6-10, only four relapses occurred during 128 person-years, corresponding to an IRR of 0.12 (95% CI=0.03-0.33) compared with year 1.

CONCLUSIONS

About 40%-50% of patients with first-episode schizophrenia will relapse despite continuous D2 blockade, apparently due to non-dopaminergic elements of the pathophysiology of the illness, as the results show that long-term dopamine receptor blockade is not associated with an increased risk of breakthrough psychosis.

Developmental trajectories of gyrification and sulcal morphometrics in children and adolescents at high familial risk for bipolar disorder or schizophrenia

Offspring of parents with severe mental illness are at increased risk of developing psychopathology. Identifying endophenotypic markers in high-familial-risk individuals can aid in early detection and inform development of prevention strategies. Using generalized additive mixed models, we compared age trajectories of gyrification index (GI) and sulcal morphometric measures (i.e., sulcal depth, length and width) between individuals at familial risk for bipolar disorder or schizophrenia and controls. 300 T1-weighted MRI scans were obtained of 187 individuals (53 % female, age range: 8-23 years) at familial risk for bipolar disorder (n = 80, n families=55) or schizophrenia (n = 53, n families=36) and controls (n = 54, n families=33). 113 individuals underwent two scans. Globally, GI, sulcal depth and sulcal length decreased significantly with age, and sulcal width increased significantly with age in a (near-)linear manner. There were no differences between groups in age trajectories or mean values of gyrification or any of the sulcal measures. These findings suggest that, on average, young individuals at familial risk for bipolar disorder or schizophrenia have preserved developmental patterns of gyrification and sulcal morphometrics during childhood and adolescence.

Unraveling sleep quality in menopausal women: objective assessments and self-reported experiences - a mini-review

Sleep is a cornerstone of health, playing an integral role in both physiological and psychological functions. However, it is vulnerable to a variety of factors including menopause. According to available research, the onset of the menopause transition may not necessarily worsen sleep architecture and could even enhance it, leading to conflict between assessment of subjective and objective sleep complaints. This discrepancy highlights the complex relationship between subjective and objective sleep quality. Understanding this relationship remains challenging due to the limited number of longitudinal studies and small sample sizes. This review explores findings from both subjective and objective sleep assessments in menopausal women and examines the impact of menopausal hormone therapy on sleep quality.

Relevance of Positive Dyadic Coping for Couples Undergoing Assisted Reproduction Treatments: A Systematic Review

The present study investigates the impact of positive dyadic coping strategies on the physical and mental health of couples undergoing assisted reproductive treatments (ART). A systematic literature search was conducted in databases, including ProQuest, PubMed, Scopus, and Web of Science, adhering to the PRISMA guidelines. From an initial pool of 1061 studies, 23 were selected for final analysis, encompassing a total of 7079 participants. The findings indicate that positive dyadic coping may significantly enhance mental health, couple adjustment and satisfaction, self-esteem, and quality of life in couples undergoing ART. The quality of the included studies was rated as moderate to high. The study concludes that integrating positive dyadic coping strategies into psychological intervention programs and providing psychological support within the healthcare system may be essential for couples undergoing ART.

Breast cancer risk among women with schizophrenia and association with duration of antipsychotic use: population-based cohort study in South Korea

BACKGROUND

Breast cancer is a major global health issue, especially among women. Previous research has indicated a possible association between psychiatric conditions, particularly schizophrenia, and an increased risk of breast cancer. However, the specific risk of breast cancer in women with schizophrenia, compared with those with other psychiatric disorders and the general population, remains controversial and needs further clarification.

AIMS

To estimate the risk of breast cancer among people with schizophrenia compared with people with other psychiatric disorders and people in the general population.

METHOD

We utilised medical claims data of women aged 18 to 80 years in the Korean National Health Information Database from 2007 to 2018. Individuals with schizophrenia were defined as women with ICD-10 codes F20 or F25 (n = 224 612). The control groups were defined as women with other psychiatric disorders (n = 224 612) and women in the general Korean population (n = 449 224). Cases and controls were matched by index date and age, in a 1:1:2 ratio. We estimated the hazard of breast cancer using the Cox proportional hazards model, adjusting for insurance premiums and medical comorbidities. Among the people with schizophrenia, we used the landmark method to estimate the association between duration of antipsychotic medication use and the incidence of breast cancer.

RESULTS

In multivariable Cox regression models, the hazard rate of breast cancer was 1.26 times higher in the people with schizophrenia than in the general population (95% CI: 1.20-1.32). In comparison with the psychiatric patient group, the hazard ratio was 1.17 (95% CI: 1.11-1.28). Among women with schizophrenia, the hazard of breast cancer was greater among those who took antipsychotic medications for 1 year or more compared with those who took antipsychotics for less than 6 months.

CONCLUSIONS

Women with schizophrenia have an elevated risk of breast cancer, and long-term use of antipsychotics is associated with an increased risk of breast cancer.

Factors associated with self-rated health in Black Canadians: A cross-sectional study

OBJECTIVES

Self-rated health (SRH) has shown to be a strong predictor of morbidity, functional decline, and mortality outcomes. This paper investigates the association between sociodemographic variables (e.g., employment, education, sex) and SRH among Black Canadians.

METHODS

We used cross-sectional survey data (n = 1380) from the A/C (African Caribbean) Study of first- and second-generation Black Canadians in Toronto and Ottawa. Participants were invited to complete an electronic survey questionnaire in English or French in 2018-2019. Generalized linear model analyses were used to evaluate the associations among sociodemographic factors and self-rated quality of health.

RESULTS

A total of 1380 self-identified Black individuals completed the survey and were included in the analysis. The majority of participants were under the age of 60 (89.7%), female (63.4%), born outside of Canada (75.1%), and residing in Toronto, Ontario (61.9%). The strongest association with poor SRH was found for difficulties accessing health care, sexual orientation, and substance misuse/disorder, while accessing/meeting basic needs was associated with better SRH, following adjustment for other socioeconomic conditions and lifestyle factors.

CONCLUSION

Our findings underscore the importance of improving the social determinants of health as a conduit to improving the general health status and the quality of life of Black Canadians. Results revealed that Black Canadians may be demonstrating high levels of resilience in circumventing their current social circumstances and structural disadvantages to live the best quality of life. Understanding sociodemographic and socio-structural barriers that Black people face is essential to reducing vulnerabilities to poor outcomes and improving their health and well-being.

Blunted niacin skin flushing response in violent offenders with schizophrenia: A potential auxiliary diagnostic biomarker

Schizophrenia (SZ) is associated with an increased risk of violence, with clinical diagnosis primarily relies on symptomatology. The niacin skin flushing response (NSFR) is proposed as a potential biomarker for SZ, but its effectiveness in violent offenders with schizophrenia (VOSZ) remains unevaluated. This study investigates whether the diagnostic model differentiating general SZ patients (GSZ) from healthy controls (HCs) using NSFR can also distinguish VOSZ from HCs. SZ patients were continuously sampled based on the International Classification of Diseases, 10th Edition, and categorized into VOSZ (with a history of violent crimes), and GSZ (without such history). HCs had no psychiatric illnesses or violent crime history. A total of 315 VOSZ, 296 GSZ, and 281 HCs were recruited. Least absolute shrinkage and selection operator regression was used to select variables and construct diagnostic models based on NSFR. No significant differences in age, sex or BMI were observed among groups. Both VOSZ and GSZ exhibited similar blunted NSFR compared to HCs. The diagnostic model constructed by 14 NSFR variables distinguishing GSZ from HCs was successfully transferred to distinguish VOSZ from HCs, with areas under the curve of 0.796 (specificity = 81.6%, sensitivity = 64.2%) and 0.798 (specificity = 80.0%, sensitivity = 70.2%), respectively. Moreover, NSFR was unrelated to illness severity, violence, or antipsychotic dosage in VOSZ, suggesting it is a trait indicator of SZ. This study supports the NSFR as an objective diagnostic biomarker for distinguishing VOSZ from HCs, expanding its applicability, although it may not specifically identify violent offenders among SZ patients.

Exercise as a transdiagnostic intervention for improving mental health: An umbrella review

Exercise is beneficial for mental health in general, but no review has systematically assessed its potential transdiagnostic nature, i.e. whether it is beneficial across specific disorders. We performed a systematic umbrella review of meta-analyses of randomized controlled trials (RCTs) of exercise in participants with mental disorders defined according to the International Classification of Diseases (ICD) or the Diagnostic and Statistical Manual of Mental Disorders (DSM), assessing exercise's transdiagnostic nature with TRANSD criteria, including eight meta-analyses (six included in the TRANSD meta-analysis), encompassing 99 RCTs (n = 5,656) across 11 disorders. Moderate/vigorous aerobic exercise was an effective transdiagnostic intervention for disease-specific primary symptoms across 11 disorders (recurrent depressive disorder, social phobia, panic disorder, generalized anxiety disorder, post-traumatic stress disorder, brief psychotic disorder, schizophrenia, schizoaffective disorder, delusional disorder, schizophreniform disorder, attention-deficit/hyperactivity disorder) and four spectra (depressive disorders, anxiety disorders, schizophrenia-spectrum disorders, neurodevelopmental disorders) with a medium effect size (SMD = -0.67, 95%CI = -0.84, -0.50). Moderate/vigorous aerobic exercise also improved cognition across two disorders (schizophrenia, attention-deficit/hyperactivity disorder) and two spectra (schizophrenia-spectrum disorders, neurodevelopmental disorders), with a large effect size (SMD = 0.92, 95%CI = 0.52, 1.33). According to TRANSD criteria, moderate/vigorous aerobic exercise is a transdiagnostic intervention to improve disease-specific primary symptoms of 11 mental disorders, and cognition in two mental disorders.

Factor Structure and Psychometric Properties of the Spence Children's Anxiety Scale: A 25-Year Systematic Review

The Spence Children's Anxiety Scale (SCAS) is one of the most used instruments to assess anxiety symptoms in children and adolescents. Extensive research has been conducted to examine its psychometric properties and to develop other versions of the scale. The objective of this study was to examine the psychometric properties and factorial structure of the SCAS across different versions and populations. This systematic review followed PRISMA guidelines and was registered. APA PsycINFO, Web of Science (Core Collection) and MEDLINE (PubMed) were searched. Fifty-two studies were included in this systematic review. They examined the factor structure, convergent and divergent validity, and internal consistency of the scale. The most supported model was the original six-factor model, followed by the higher order six-factor model for the long version of the SCAS. Studies provided evidence of convergent validity and internal consistency. It is concluded that the SCAS is a valid and reliable instrument for assessing anxiety symptoms in children and adolescents, with a six-factor model structure well supported in most populations. Further research on the psychometric properties and factor structure of other versions of the scale and its application to clinical populations is warranted.

COVID-19-Related Changes in Adolescents' Daily-Life Social Interactions and Psychopathology Symptoms

ABSTRACT

The COVID-19 pandemic is believed to have strongly impacted adolescents' mental health through limiting their day-to-day social lives. However, little is known about the role of (social) risk/protective factors and adolescent mental health. Subclinical psychopathology, and risk and protective factors of n = 173 adolescents (T1 mean age = 16.0; 89% girls) were assessed prepandemic and early-pandemic (T1: 2018/2019; T2: May 2020). Daily-life social interactions were assessed in 6-day experience sampling periods. Correcting for age, multilevel analyses revealed declines in general psychopathology and anxiety symptoms; fewer face-to-face social interactions, more online social interactions; and higher-quality face-to-face interactions during the pandemic than before. Negative associations between psychopathology and the quality of face-to-face peer and family interactions were stronger during the pandemic than prepandemic. The results reflect that, early in the pandemic, the mental health impact on adolescents may have been limited. High-quality face-to-face interactions with family and peers seemed particularly powerful in keeping adolescents resilient.

DMN network and neurocognitive changes associated with dissociative symptoms in major depressive disorder: a research protocol

Introduction

Depression is a heterogeneous disorder with diverse clinical presentations and etiological underpinnings, necessitating the identification of distinct subtypes to enhance targeted interventions. Dissociative symptoms, commonly observed in major depressive disorder (MDD) and linked to early life trauma, may represent a unique clinical dimension associated with specific neurocognitive deficits. Although emerging research has begun to explore the role of dissociation in depression, most studies have provided only descriptive analyses, leaving the mechanistic interplay between these phenomena underexplored. The primary objective of this study is to determine whether MDD patients with prominent dissociative symptoms differ from those without such symptoms in clinical presentation, neurocognitive performance, and markers of functional connectivity. This investigation will be the first to integrate comprehensive clinical evaluations, advanced neurocognitive testing, and high-resolution brain imaging to delineate the contribution of dissociative symptoms in MDD.

Methods

We will recruit fifty participants for each of three groups: (1) depressive patients with dissociative symptoms, (2) depressive patients without dissociative symptoms, and (3) healthy controls. Diagnostic assessments will be performed using the Structured Clinical Interview for DSM-5 (SCID) alongside standardized scales for depression severity, dissociation, and childhood trauma. Neurocognitive performance will be evaluated through a battery of tests assessing memory, attention, executive function, and processing speed. Structural and functional magnetic resonance imaging (MRI) will be conducted on a 3 Tesla scanner, focusing on the connectivity of the Default Mode Network with key regions such as the orbitofrontal cortex, insula, and posterior cingulate cortex. Data analyses will employ SPM-12 and Matlab-based CONN and PRONTO tools, with multiclass Gaussian process classification applied to differentiate the three groups based on clinical, cognitive, and imaging data.

Discussion

The results of this study will introduce a novel perspective on understanding the connection between major depressive disorder and dissociation. It could also aid in pinpointing a distinct form of depression associated with dissociative symptoms and early childhood stressors.

Conclusion

Future research, aiming to forecast the response to biological and psychological interventions for depression, anticipates this subtype and provides insights.